HIR Wellness Institute - Community Survey 2022

The following Community Survey questions will take approximately 5 minutes to complete. There are 20 questions and the responses are in multiple choice form as strongly disagree, disagree, neither agree nor disagree, agree, strongly agree, and prefer not to answer. All information provided is used solely to inform our services and is kept confidential. None of your identifying information is used.

1.In the past month, I have been getting quality sleep with regular bed times and getting up times.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly Agree
Prefer not to answer
2.In the past month, I have been isolating myself from friends, family or co-workers.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly Agree
Prefer not to answer
3.In the past month, I have had more worries or anxiety than usual.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly Agree
Prefer not to answer
4.In the past month, I have lost interest in activities that usually held my attention.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly Agree
Prefer not to answer
5.In the past month, I have felt more sad than happy.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly Agree
Prefer not to answer
6.In the past month, I feel at ease with myself and my surroundings.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly Agree
Prefer not to answer
7.In the past month, I feel that my life has been appropriately balanced between work, fun, friends, family, self-care, exercise, and other meaningful pursuits.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly Agree
Prefer not to answer
8.In the past month, I have had trouble concentrating
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly Agree
Prefer not to answer
9.In the past month, I have been experiencing significant mood swings, crying, or thoughts of taking my own life.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly Agree
Prefer not to answer
10.In the past month, I have been overly fatigued or tired at the end of the day.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly Agree
Prefer not to answer
11.In the past month, my appetite or eating habits have changed.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly Agree
Prefer not to answer
12.I believe I had these problems or issues listed above before the pandemic.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly Agree
Prefer not to answer
13.Covid specific: In the last 12 months, I believe that COVID-19 has negatively impacted my life.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly Agree
Prefer not to answer
14.Covid specific: In the last 12 months, I believe COVID-19 has made it more difficult to find mental health services.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly Agree
Prefer not to answer
15.Covid specific: In the last 12 months, I believe my support system decreased because of COVID-19.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly Agree
Prefer not to answer
16.Covid specific: In the last 12 months, I believe the media coverage on COVID-19 has impacted my current mental health in a negative way.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly Agree
Prefer not to answer
17.Racism specific: In the last 12 months, I believe that racism impacts my current mental health in a negative way
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly Agree
Prefer not to answer
18.Racism specific: In the last 12 months, I believe that the social unrest and injustice in our communities and nation impacts my current mental health in a negative way.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly Agree
Prefer not to answer
19.Racism specific: In the last 12 months, I believe that racial injustice impacts my current mental health in a negative way.
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly Agree
Prefer not to answer
20.Is there anything else you would like to share?
Current Progress,
0 of 20 answered